Facial Fat Graft Feels Hard Post-procedure

I had an analogous fat transfer to the upper cheeks and orbital region. The fat feels hard like a rock underneath the skin. Is this normal? Should I massage it? I can also feel uneven areas on the outmost region of the cheeks. Does hardness indicate that the fat cells died in the process? What should I expect from here?

Doctor Answers 22

Depends on the timing


The massage should be guided by your surgeon as opionions vary.

You did not specify the timing of your procedure as this can be important in the evolution of the post operative findings.

Firmness as Dr. Law documented can vary as a result of :

  1. area injected i.e. cheek bone/ tear trough fat will feel firmer than cheek hollows
  2. volume injected
  3. amount of associated bleeding bruising
  4. degree of "fat take" survival

Firmness is common with any procedure for the first 4 days. As the blood supply reaches or doesn't reach the fat cells some will die "fat necrosis" and trigger a process of inflammation and fibrosis (scarring) which will typically develop over a 3 week period. By 6 weeks, this process is generally completed and the areas continue to soften.

Therefore the 3 week period is a good time to assess the results of the lipoinjection procedure. While it may remain slightly overcorrected at this point, a soft area indicates good fat survival whereas a firm area indicates poor fat survival. This may be the result of a variety of factors and not always directly attributable to the technique. For example, a history of smoking contributes to poor fat survival as does previous scarring or surgery in the area. Aspirin or NSAID use may cause greater amounts of bleeding which can also be pericieved as hard

If other procedure have been simultaneously performed in the same area, this can also contribute to sensations of irregularity and firmness.

Rarely the fat may die and form a cyst or an abscess which needs to be drained or aspirated.

I hope this helps.

Chicago Plastic Surgeon
5.0 out of 5 stars 58 reviews

Palpable fat grafts after surgery

Early after surgery, almost every graft becomes firm to some extent. This is due to the healing around the graft and the metabolism away of, or encapsulation of, dead tissue.

With fat injection, many of the cells die before they are even injected. I believe this is inherent in the fat injection process where living cells are harvested under a vacuum and then injected. Our histoloogy studies have also confirmed this.

So in the first several months after surgery, this is normal.

If at six months or more after surgery, hard palpable lumps are present, it is possible that cells from the fat injection have died and have been walled off (encapsulated). If they are bothersome, they can be removed surgically. Otherwise, they are often left alone.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 118 reviews

Hardness/ Firmness after Fat Transfer to Face is not common

With regards to FAT TRANSFER to face these are important points to consider;

  • Some degree of hard or lumpy region within the area of transplanted fat can happen after procedure.
  • It is important to be evaluated by your surgeon. He should guide you as to the degree, intensity  and frequency of massaging.
  • Unless there is granuloma or infection the hardness should  resolve shortly.

Hope this helped.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 176 reviews

Hard/lumpy areas after facial fat transfer

It is entirely normal - and expected - to feel firm/hard/lumpy areas for the first few months after fat transfer to the face. These islands of swollen tissue will soften with time.

Visible lumps, on the other hand, are more tricky. Your surgeon's judgment will help decide how they should be managed: massage, steroid injection, or other treatments.

Facial fat transfer, artfully done, is a problem that creates happy patients and good results. Try to weather the uncertainty of the first several weeks, and you'll likely be fine.

Good luck,

Mike Nayak

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 129 reviews

Facial Fat Graft Feels Hard Post-procedure

After autologous fat graft  to the face is not unusual to experience some harness of the area. This can be secondarily to scar tissue. However,  you should be evaluated by your surgeon because fat necrosis initially will present as a hard area

Jaime Perez, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 49 reviews

Results after fat grafting to face

Fat grafting to face is a very effective and powerful procedure. This is performed through very small needles and by adding a drop of fat at a time. When we transplanted fat from one area of the body to the other we can expect approximately 20% of this fat melt away. It sounds as if you are in the middle of the healing process. You should expect the fat to become progressively more soft until you reach your final result at about 6 to 8 months. At that time, if you continue to have areas of firmness or areas that are uneven, return to your plastic surgeon for evaluation. They may recommend additional fat grafting to help even out the areas or the injection of medication that will help smooth the areas out.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 67 reviews

Fat graft take

Fat grafting is a nice way to provide autologous tissue augmentation. Hardness can mean alot of diffirent things at different times. If it si early post-op, it may mean nothing. If it is longer than say the first few weeks, it may represent scar tissue or grafts that have not taken well and are undergoing fat necrosis and resorption.

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 21 reviews

Fat grafted takes on the qualities of nearest tissue

Fat grafting is an excellent way to bring youth to your face. Losing volume plays a huge part in the aging process. Hence, replacing this fat to the face can reverse a lot of the aging that has occurred within the face.

One rule in fat grafting is that fat will take on the characteristics of the tissue that it is placed near or on. Hence the fat that is placed on your cheek bone will feel like bone, etc. During the post procedure phase, however, the fat will feel hard due to the inflammation that it is undergoing. Fat is one of the most inflammatory substances in the body and hence it will lead to a lot of inflammation.

The key during the healing phase is to be patient. It will eventually soften and feel more like your own tissue.

Consulting a Board Certified Facial Plastic Surgeon would be something that I recommend. We specialize in the face and are highly qualified to help you with this.

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.5 out of 5 stars 43 reviews

Is "the orbital region" the eyelids?

If you are referring to fat injections in the lower eyelid, you might be experiencing a fairly regularly reported problem in that area. The skin there is usually pretty thin, and resorption of the fat is common. Although you might see a good result initially, uneven withering of the fat can lead to an unfavorable appearance and areas of firmness later - even months and years later. These changes can be especially noticeable as your weight fluctuates.

I'd recommend that you follow the advice of your surgeon.

Brian K. Brzowski, MD
Ogden Plastic Surgeon
5.0 out of 5 stars 47 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.